 THERE ARE THREE IMPORTANT SITES
OF PRIMARY INFECTION IN ACTINOMYCOSIS. THE PUS CONTAINS COLONIES OF THE
ORGANISM. WHICH ARE CALLED AS SULPHUR GRANULES.
.

.1.
 IT OCCURS BY DIRECT EXTENSION
FROM A PERIODONTAL ABSCESS. CERVICOFACIALPRIMARY LESION IS USUALLY IN THE MANDIBLE OR MAXILLA. DENTAL EXTRACTION OR ACCIDENTAL FRACTURE OF JAW. NEGLECTED CARIOUS OR BROKEN TEETH.

THORACIC
IT OCCURS IN LUNGS AS A RESULT OF ASPIRATION OF HYPHAL FRAGMENTS OF ACTINOMYCES FROM TOOTH SURFACES OR DENTAL CARIES .2.
 THE LESION IN THE LUNG MAY INVOLVE
PLEURA AND PERICARDIUM.
.
 IT SPREADS OUTWARDS THROUGH THE
CHEST WALL PRODUCING MULTIPLE DRAINING SINUSES.

.2. CULTURE SULPHUR GRANULES ARE WASHED THOROUGHLY IN STERILE NORMAL SALINE .
 THEY ARE CRUSHED IN A DROP OF
SALINE WITH A GLASS ROD.  THEN THEY ARE INOCULATED ON  BRAIN HEART INFUSION AGAR. BLOOD AGAR & IN THIOGLYCOLLATE BROTH.

ENTIRE OR LOBULATED RESEMBLING MOLAR TEETH.
 THE COLONIES ARE 0.5-2mm IN
DIAMETER. THEY ARE INCUBATED BOTH
AEROBICALLY & ANAEROBICALLY IN 5-10 % CO2 AT 35-37°C FOR UPTO 14 DAYS.
. WHITE TO GREY-WHITE. SMOOTH.

 GROWTH IS FURTHER CONFIRMED BY
DIRECT FLUORESCENCE MICROSCOPY AND BIOCHEMICAL TESTS.
.

FIBROSING. INFLAMMATORY PROCESS.
 THE TISSUE REACTION IS A CHRONIC
SUPPURATIVE. THE SULPHUR GRANULES ARE DEEPLY STAINED WITH HAEMATOXYLIN EXCEPT AT PERIPHERY WHICH IS STAINED BY EOSIN. BIOPSY  IN HAEMATOXYLIN AND EOSIN STAINED SECTIONS.3.
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